Provider Demographics
NPI:1992165658
Name:FLORES, LENA NICKOLE
Entity type:Individual
Prefix:
First Name:LENA NICKOLE
Middle Name:
Last Name:FLORES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9125 GARRETT LAKE DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31820-4285
Mailing Address - Country:US
Mailing Address - Phone:270-312-2645
Mailing Address - Fax:
Practice Address - Street 1:9125 GARRETT LAKE DR
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:GA
Practice Address - Zip Code:31820-4285
Practice Address - Country:US
Practice Address - Phone:270-312-2645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-24
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula